If there’s any silver lining to the pandemic then it has to be the modernization of benefit plans that occurred over the past three years. COVID-19 pushed an industry that was slowly digitizing to move quickly to meet the rapidly evolving needs of its employers and plan members. Suddenly, virtual care, which had been lagging in terms of adoption, has become top of mind, with virtual offerings replacing or complementing many in-person services. The bar has been raised—and benefits plans are evolving to meet these new expectations.
“We are on the cusp of the transformation of benefits plans as we knew them,” says Colleen Adams, Director, Business Enablement - Payor Solutions, at TELUS Health. “We’re looking at benefits with a new lens with the member at the centre of care, and technology as an enabler to innovation, navigation and service delivery.”
As we head into 2023, many changes will be front and centre. Virtual care will be the new normal, and benefits plans will have to be fluid and adaptable to serve the needs of the various plan populations who depend on them. Mental health will also continue to be a focal point, with increasing priority placed on wellness and proactive supports. With costs of chronic conditions on the rise, there will be more attention paid to prevention strategies and holistic care models. Benefits plans will become more personalized, moving away from the cookie cutter models of previous years to offer tailored coverage and meaningful navigation experiences.
1. Virtual care is here to stay.
Virtual care used to be a pie-in-the-sky concept. Not anymore. When COVID-19 hit in 2020, “Virtual care was in its infancy in Canada,” says Adams. But because of the pandemic, choices for care were limited. And that forced the industry to accelerate acceptance and adoption of care virtually, making it a new standard of care, she says.
She says many plan sponsors realized that virtual care can provide critical telehealth services to people working from home, living in remote communities, those infected by transmissible illnesses, the mobility-challenged–and can be as effective as in-person patient care. That’s because it can provide rapid diagnosis, prescriptions or referrals to specialized care or mental health support–all from the comfort of a plan member’s home. That care extends to other family members–older family members and children—meaning that working parents can look after their family’s care more efficiently and as stress-free as possible.
On the employer’s end, there is higher productivity and less absenteeism as employees can access care from the office or after hours, ensuring their work hours are less affected. From a total rewards perspective, virtual care offers a compelling value proposition to attract and retain top talent. “Employers are looking to keep employees happy, healthy and engaged,” says Adams. “There’s a great return on investment there – it’s a win-win for everyone,” she says.
2. Mental health supports will continue to expand.
COVID-19 had a profound impact on mental health, now known as the shadow pandemic. And employers are taking action on this front. “There’s a renewed and ongoing focus on mental health,” says Adams. “We’ve seen so many employers increase their mental health benefit maximums,” she says. “This gives a lot more flexibility for care.”
A September 2022 Benefits Canada survey found that a quarter (24 per cent) of plan sponsors recently increased their maximum level of coverage for mental-health counselling, up from 19 per cent in 2021 and 18 per cent in 2020. An additional 28 per cent indicated they plan to increase their maximum, the research found.
As plan sponsors are broadening coverage, they are also rediscovering valuable mental health supports offered through their benefits plan’s Employee Assistance Program (EAP), whether that’s in-person, over the phone or via virtual counselling, access to mindfulness, or other self-guided programs. Many are focusing on eliminating the stigma around mental health by encouraging dialogue and providing more information around what mental health services they offer–and how best to access those services.
“Employers today are realizing mental health support is more than one standalone solution –you really have to build a plan that includes robust coverage, offers choice of modality and enables easy access to care,” says Adams.
3. Employers are looking harder at prevention strategies.
The industry is waking up to the value of stressing prevention when it comes to achieving and maintaining good health. Many plan sponsors are introducing wellness programs that can help employees identify risk factors for preventable diseases and promote strategies to improve their short- and long-term mental, physical and financial health.
“Focusing on early intervention and having a wellness-focused approach to care, that is where there is so much potential to positively impact health outcomes,” says Adams. “We’re going to see more employers investing in this space and new solutions hitting the market to meet this demand.”
She says that with employers’ spending pulled back earlier in the continuum of care, this focus on the pre-disability space could very likely prevent or reduce costly short- or long-term disability leaves.
4. Plans will become more personalized.
One size does not fit all and plan sponsors are getting that message. Adams says that employers are striving to bring “their plans to life,” not just investing in more offerings but also customizing them to the specific needs of their workforce. This involves offering flex plans to allow à la carte coverage and adding spending accounts to meet more diverse needs. It also means embracing navigation to steer members to the right care or coverage at the right time.
“They are seeking to deliver personalized care through smart recommendations that can connect the dots between available coverage and emerging needs and then present solutions that employees want,” says Adams. This could direct plan members to specific, tailored interventions to optimize treatment and health outcomes. For example, when a plan member fills a prescription for a new medication, they might be directed to other complementary health supports - seamlessly within a care ecosystem. The goal is to offer digital navigation to ensure members can easily understand and access the services the plan offers.
Adams says that in addition to personalizing plan offerings, plan sponsors - and employees - are continuing to explore the value of personalized treatment. Pharmacogenetics which identifies genetic causes of how a person responds to a medication can determine which drugs will work optimally to prevent plan members from trying medications that won’t work as effectively - saving time, side effects and frustration.
“That’s taking personalization to the genetics level,” says Adams. “That is going to be a big part of the future.”
5. Chronic disease care will be tackled more holistically.
Chronic disease remains a top driver of plan costs and that trend is expected to continue. What we’re seeing now is a broader and more holistic lens being applied to treatment and self-care solutions. Adams says that although drug therapies will still be central to treatment plans, more attention will be paid to complementary approaches that can also improve symptoms.
This will occur by recognizing the connection between physical and mental health and curating programs that take care of both. For example, with a condition such as diabetes, care will always be taken to monitor blood glucose levels. However, a comprehensive future approach will also include support around the value of healthy eating, exercise, stress reduction and counselling to learn to live well with a chronic disease, empowering the member to make better choices and to take charge of their care.
“I think we’ll see more focus on taking care of the whole person,” says Adams, “and I think employers will embrace this approach to better support their employees.
All in all, in 2023 benefits plans will have to continually evolve to ensure their varied benefits populations are well-served, largely due to ever-increasing customer expectations.
“We’re going to be seeing the transformation of benefits plans where priorities are placed on choice, flexibility and health outcomes,” says Adams. “Solutions will be easy to navigate, personalized and driven by technology. It’s going to be great.”